Fulminant Laryngeal-tracheobronchial-pulmonary Aspergillosis: A Rare and Fatal Complication in Allogeneic Hematopoietic Stem Cell Transplantation Recipients

Abstract

A 23-year-old man who had previously undergone allogeneic hematopoietic stem cell transplantation (allo-HSCT) for severe aplastic anemia was diagnosed with invasive laryngeal-tracheobronchial-pulmonary aspergillosis after presenting with a persistent dry cough at six months post-transplantation based on the findings of laryngoscopy and fiberoptic bronchoscopy. A fiberoptic bronchoscope was used to remove the obstructive material from the patient's airway and posaconazole plus caspofungin were administered to successfully to treat the patient. Our report suggests that laryngoscopy and fiberoptic bronchoscopy should be considered as alternative approaches to the diagnosis and treatment of allo-HSCT recipients with persistent respiratory symptoms when invasive laryngeal aspergillosis and invasive tracheobronchial aspergillosis are suspected.

Invasive Tracheobronchial Aspergillosis with Bronchial Ulcers Complicated by Nontuberculous Mycobacterial Disease

“…ITBA is a rare form of invasive pulmonary aspergillosis. In previous reports, immunocompromised patients, such as those who had received organ or bone marrow transplantation, those being treated with immunosuppressive agents such as steroids and those suffering from acquired immu- (6,(10)(11)(12). The symptoms are usually non-specific, such as cough, dyspnea and respiratory failure (9,13,14).…”

Fulminant Tracheobronchial Aspergillosis in an Apparently Healthy Adult

“…Tracheobronchial aspergillosis is a well-recognized phenotype of rare invasive pulmonary aspergillosis (IPA); patients suspected of having tracheobronchial aspergillosis require admission to an intensive-care unit and prompt initiation of antifungal therapy (1)(2)(3)(4)(5)(6)(7)(8)(9)(10). We encountered a fatal case of fulminant tracheobronchial aspergillosis in an apparently healthy adult, although most of the previously reported patients with tracheobronchial aspergillosis and IPA were immunocompromised (1)(2)(3)(4)(5)(6)(7)(8)(9)(10).…”